Prematurity and Low Birth Weight — MCQs
In a preterm baby with respiratory distress syndrome, which of the following lipids would be deficient?
Which of the following is the principal mode of heat exchange in an infant incubator?
Which of the following is NOT included in the resuscitation of a neonate with HR < 60/min?
Which of the following is a criterion for infant at risk?
In a case of preterm labor, which steroid is used to enhance fetal lung maturity?
Which of the following is best for the transport of a newborn, ensuring maintenance of a warm temperature?
Neonatal tetanus prevention is best done by which antenatal measure?
All of the following are true for retinopathy of prematurity except which of the following?
A woman delivers a healthy baby with weight 2.2 kg at the time of birth. What measures are to be taken? 1. The baby should be exclusively breast fed for first six months 2. The vaccination with OPV and BCG should be delayed till the baby is 2.5 kg of weight 3. Baby should be kept with mother and kangaroo care to be given Select the correct answer using the code given below:
A 30-year-old female P2L2 had a forceps delivery 2 days back. There was injury to head of baby resulting in collection of blood in soft tissue between pericranium and flat bone of skull, limited by suture line. What is the probable diagnosis?
Prematurity and Low Birth Weight Indian Medical PG Practice Questions and MCQs
Question 1: In a preterm baby with respiratory distress syndrome, which of the following lipids would be deficient?
- A. Cardiolipin
- B. Sphingomyelin
- C. Phosphatidylinositol
- D. Lecithin (Correct Answer)
Explanation: ***Lecithin*** - **Lecithin** (also known as **phosphatidylcholine**) is the primary component of **surfactant** in the lungs, which reduces surface tension and prevents alveolar collapse. - In **preterm babies**, insufficient production of lecithin due to immature lung development leads to **respiratory distress syndrome (RDS)**. *Cardiolipin* - **Cardiolipin** is a major phospholipid found in the **inner mitochondrial membrane**, crucial for oxidative phosphorylation. - Deficiency is associated with mitochondrial disorders like **Barth syndrome**, not primary respiratory distress. *Sphingomyelin* - **Sphingomyelin** is a significant component of **cell membranes** and **myelin sheaths**, important for nerve insulation. - While present in the lungs, its primary role is not in surface tension reduction, and its deficiency is not directly linked to RDS. *Phosphatidylinositol* - **Phosphatidylinositol** is a precursor for various **signaling molecules** and plays a role in cell membrane structure. - While involved in cellular processes, it is not the critical surfactant component whose deficiency causes RDS.
Question 2: Which of the following is the principal mode of heat exchange in an infant incubator?
- A. Radiation
- B. Evaporation
- C. Convection (Correct Answer)
- D. Conduction
Explanation: ***Convection*** - In an infant incubator, **convection** is the primary method of heat transfer where a fan circulates warm air around the infant. - This controlled circulation of warm air helps maintain a stable thermal environment for the neonate. *Radiation* - **Radiation** involves heat transfer through electromagnetic waves, and while it occurs, it's not the primary mode in a typical closed incubator, which aims to minimize radiant heat loss to cooler surfaces. - Radiant warmers, used for open care, primarily rely on radiation, but these are distinct from closed incubators. *Evaporation* - **Evaporation** is the loss of heat through the conversion of liquid (sweat or insensible water loss) to vapor, but incubators aim to minimize this by maintaining optimal humidity. - Excessive evaporative heat loss can be significant in premature infants, but it is a mode of *heat loss*, not the principal *mode of heat exchange* for maintaining warmth in an incubator. *Conduction* - **Conduction** is direct heat transfer through physical contact, such as between the infant's skin and the mattress. - While incubators have warm mattresses to prevent conductive heat loss, the circulating warm air (convection) is the main mechanism for overall temperature control.
Question 3: Which of the following is NOT included in the resuscitation of a neonate with HR < 60/min?
- A. Endotracheal tube intubation
- B. Chest compression
- C. Adrenaline
- D. None of the above (Correct Answer)
Explanation: ***None of the above*** - All listed interventions—**endotracheal tube intubation**, **chest compressions**, and **adrenaline administration**—are standard components of neonatal resuscitation when the heart rate remains below 60 beats/min despite initial steps. - This question asks which is *NOT* included, implying that all options are, in fact, appropriate interventions in this critical scenario. *Endotracheal tube intubation* - This is a critical step in **securing the airway** and ensuring effective positive pressure ventilation when other methods fail or prolonged mechanical ventilation is anticipated. - It's indicated if the heart rate remains below 60 bpm despite adequate bag-mask ventilation and chest compressions. *Chest compression* - **Chest compressions** are initiated when the heart rate is less than 60 bpm *after* 30 seconds of effective positive pressure ventilation. - They are used in conjunction with positive pressure ventilation to improve cardiac output and myocardial perfusion. *Adrenaline* - **Adrenaline** is administered if the heart rate remains below 60 bpm *despite* adequate ventilation and chest compressions. - It acts as a potent **vasopressor** and **cardiac stimulant**, increasing heart rate and contractility.
Question 4: Which of the following is a criterion for infant at risk?
- A. Preeclampsia in pregnancy (Correct Answer)
- B. Has not taken 100 days folic acid
- C. Malpresentation during birth
- D. Working mothers
Explanation: ***Preeclampsia in pregnancy*** - **Preeclampsia** is a serious pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys. - Infants born to mothers with preeclampsia are at **significantly higher risk** for complications including **preterm birth**, **intrauterine growth restriction (IUGR)**, low birth weight, respiratory distress syndrome, and perinatal mortality. - This is a **universally recognized criterion** for identifying high-risk infants in maternal-child health programs and NICU protocols. - Such infants require close monitoring and specialized care from birth. *Has not taken 100 days folic acid* - Periconceptional **folic acid supplementation** (ideally starting 3 months before conception and continuing through early pregnancy) reduces the risk of **neural tube defects** in the fetus. - While lack of folic acid supplementation increases the risk of congenital anomalies during pregnancy, this historical factor alone does not classify the infant as "at risk" after birth unless an actual neural tube defect or other complication is present. - This is primarily a **pregnancy risk factor** rather than a postnatal infant risk criterion. *Malpresentation during birth* - **Malpresentation** (e.g., breech, transverse lie, face presentation) increases the risk of birth complications such as **birth asphyxia**, **birth trauma**, cord prolapse, and difficult delivery. - While malpresentation is recognized as a risk factor during delivery and such infants may require closer initial monitoring, **preeclampsia** represents a more comprehensive and persistent risk affecting multiple organ systems and long-term outcomes. - In the context of identifying high-risk infants for follow-up programs, maternal preeclampsia is a more significant criterion than malpresentation alone (assuming no birth complications occurred). *Working mothers* - A mother's employment status does not inherently classify an infant as "at risk" from a medical or developmental standpoint. - While **socioeconomic factors** and access to care can impact infant health, simply being a working mother is not a direct medical criterion for defining an infant as high-risk.
Question 5: In a case of preterm labor, which steroid is used to enhance fetal lung maturity?
- A. Dexamethasone (Correct Answer)
- B. Prednisolone
- C. Methylprednisolone
- D. Hydrocortisone
Explanation: ***Dexamethasone*** - **Dexamethasone** is one of the two corticosteroids recommended for enhancing **fetal lung maturity** in preterm labor (the other being betamethasone). - It effectively crosses the placenta to stimulate **surfactant production** and lung structural maturation in the fetus. - Standard regimen: **6 mg IM every 12 hours for 4 doses** between 24-34 weeks of gestation. - Among the options provided, this is the **correct choice** for antenatal corticosteroid therapy. *Prednisolone* - **Prednisolone** is NOT used for fetal lung maturity as it is largely **inactivated by placental 11β-hydroxysteroid dehydrogenase**, limiting its transfer to the fetus. - Its efficacy in stimulating **fetal lung development** is significantly lower compared to dexamethasone or betamethasone. *Methylprednisolone* - Similar to prednisolone, **methylprednisolone** is also significantly **metabolized by the placenta**, reducing its availability to the fetus. - It is **not recommended** for **fetal lung maturity enhancement** in preterm labor. *Hydrocortisone* - **Hydrocortisone** has a shorter half-life and weaker potency compared to dexamethasone, making it ineffective for enhancing **fetal lung maturity**. - It does not achieve optimal fetal concentrations for the desired therapeutic effect in preterm labor.
Question 6: Which of the following is best for the transport of a newborn, ensuring maintenance of a warm temperature?
- A. Skin-to-skin contact method
- B. Portable temperature-controlled device (Correct Answer)
- C. Heated water container
- D. Insulated thermal box
Explanation: **Portable temperature-controlled device** ✓ - A **portable temperature-controlled device**, such as an infant transport incubator, is specifically designed to maintain a stable and warm environment for newborns during transfer - These devices offer precise **thermoregulation**, protection from environmental factors, and allow for continuous monitoring and interventions during transport - This is the **gold standard** for neonatal transport, ensuring optimal temperature maintenance *Skin-to-skin contact method* - While excellent for immediate bonding and initial warmth in stable newborns, **skin-to-skin contact** cannot consistently maintain optimal temperature during prolonged or inter-facility transport - It requires constant close contact with a caregiver and limits medical interventions during transport - Not suitable for sick or unstable newborns requiring monitoring *Insulated thermal box* - An **insulated thermal box** offers passive warmth retention but lacks active temperature control and monitoring - Cannot prevent heat loss effectively over extended periods or compensate for fluctuations in external temperature - No provision for medical interventions during transport *Heated water container* - A **heated water container** is not a standard or safe method for maintaining newborn temperature during transport - Carries significant risks of burns, inconsistent warming, and potential for rapid cooling once the heat source diminishes - Unsafe and not recommended for neonatal care
Question 7: Neonatal tetanus prevention is best done by which antenatal measure?
- A. Tetanus toxoid (Correct Answer)
- B. Tetanus immunoglobulin
- C. Antibiotics (e.g., Penicillin)
- D. Antibiotics (e.g., Metronidazole)
Explanation: ***Tetanus toxoid*** - **Tetanus toxoid vaccination** of pregnant women stimulates **active immunity** in the mother, leading to production of protective antibodies. - These maternal IgG antibodies cross the placenta and provide **passive immunity** to the fetus/neonate, protecting against neonatal tetanus. - Neonatal tetanus is often acquired through umbilical stump infection with *Clostridium tetani* spores in unhygienic delivery conditions. - **WHO recommends** at least 2 doses of TT during pregnancy for prevention of neonatal tetanus. *Tetanus immunoglobulin* - **Tetanus immunoglobulin (TIG)** provides immediate **passive immunity**, but its effect is short-lived (3-4 weeks). - It's used for **post-exposure prophylaxis** or treatment in individuals who are unimmunized or inadequately immunized. - Not practical or recommended for routine antenatal prevention due to short duration, high cost, and need for repeated administration. *Antibiotics (e.g., Penicillin)* - While penicillin can be used as part of **tetanus treatment** to kill *Clostridium tetani* bacteria, it does not provide **preventive immunity** to the fetus. - Antibiotics do not neutralize the tetanus toxin or provide antibodies for passive immunity. - They have no role in antenatal prevention of neonatal tetanus. *Antibiotics (e.g., Metronidazole)* - **Metronidazole** is another antibiotic used to treat *Clostridium tetani* infection. - Like penicillin, it does not confer **immunity** (active or passive) to the neonate. - Not an effective antenatal measure for preventing neonatal tetanus.
Question 8: All of the following are true for retinopathy of prematurity except which of the following?
- A. Due to hypoxia there occurs neovascularization followed by fibroproliferation
- B. Occurs in premature infants due to abnormal retinal blood vessel development.
- C. End result is bilateral blindness (Correct Answer)
- D. Blindness can be prevented by early diagnosis and ablation of avascular peripheral retina with cryotherapy or photocoagulation
Explanation: ***End result is bilateral blindness*** - While retinopathy of prematurity (ROP) can lead to severe vision loss or blindness, it is not always a bilateral end result, especially with early diagnosis and treatment. The severity can vary between eyes, and some cases resolve spontaneously. - Modern screening and intervention strategies, such as laser photocoagulation or anti-VEGF injections, are often successful in preventing complete blindness in one or both eyes. *Due to hypoxia there occurs neovascularization followed by fibroproliferation* - This statement accurately describes the pathogenesis of ROP. The initial phase involves delayed normal retinal vascularization, followed by a proliferative phase characterized by **neovascularization** in response to hypoxia in the avascular retina. - These new, abnormal vessels are fragile and prone to bleeding, and their associated **fibrovascular proliferation** can lead to retinal detachment. *Blindness can be prevented by early diagnosis and ablation of vascular premature retina with cryotherapy or photocoagulation* - This is a true statement. **Early diagnosis** through ophthalmologic screening of premature infants is crucial, and treatments like **laser photocoagulation** or **cryotherapy** are effective in ablating the avascular peripheral retina to halt the progression of abnormal vessel growth. - These interventions reduce the hypoxic drive that fuels neovascularization, thereby preventing severe retinal detachment and subsequent blindness. *Occurs in premature infants due to abnormal retinal blood vessel development.* - This statement is correct. ROP is a disease primarily affecting **premature infants** because their retinal blood vessels have not completed development by the time of birth. - Postnatal factors, including oxygen fluctuations and low birth weight, further disrupt this critical development, leading to **abnormal vascularization**.
Question 9: A woman delivers a healthy baby with weight 2.2 kg at the time of birth. What measures are to be taken? 1. The baby should be exclusively breast fed for first six months 2. The vaccination with OPV and BCG should be delayed till the baby is 2.5 kg of weight 3. Baby should be kept with mother and kangaroo care to be given Select the correct answer using the code given below:
- A. 2 and 3 only
- B. 1 and 2 only
- C. 1, 2 and 3
- D. 1 and 3 only (Correct Answer)
Explanation: ***1 and 3 only*** - **Exclusive breastfeeding** for the first six months is crucial for **nutrition** and **immunity**, especially for low birth weight babies. - **Kangaroo Mother Care (KMC)**, involving skin-to-skin contact, helps regulate the baby's temperature, promotes bonding, and supports weight gain in LBW infants. *2 and 3 only* - While **Kangaroo Mother Care (KMC)** is appropriate for this baby, the recommendation to delay vaccination is incorrect. - **BCG vaccination** should be given at birth to babies weighing **≥2 kg** as per IAP guidelines, so a 2.2 kg baby qualifies for immediate vaccination. *1 and 2 only* - **Exclusive breastfeeding** is appropriate, but delaying vaccinations is not indicated for a baby weighing 2.2 kg. - **BCG** is given at birth for babies ≥2 kg, and routine immunization schedule should be followed without delay based on birth weight alone. *1, 2 and 3* - While statements 1 and 3 correctly identify beneficial practices (exclusive breastfeeding and kangaroo care), statement 2 is incorrect. - **Vaccination guidelines** (IAP/UIP) recommend administering **BCG at birth** for babies ≥2 kg, and routine immunizations as per schedule without weight-based delays for a 2.2 kg baby.
Question 10: A 30-year-old female P2L2 had a forceps delivery 2 days back. There was injury to head of baby resulting in collection of blood in soft tissue between pericranium and flat bone of skull, limited by suture line. What is the probable diagnosis?
- A. Cephalhaematoma (Correct Answer)
- B. Subgaleal haemorrhage
- C. Caput succedaneum
- D. Intraventricular haemorrhage
Explanation: ***Cephalhaematoma*** - A **cephalhaematoma** is a collection of blood between the **pericranium** and the skull bone, which is characteristically limited by the **suture lines**. This perfectly matches the clinical description. - It is often associated with **traumatic deliveries** like forceps delivery due to shearing forces on the skull and can appear hours to days after birth. *Subgaleal haemorrhage* - A **subgaleal haemorrhage** involves bleeding into the **potential space between the epicranial aponeurosis and the periosteum** (galea aponeurotica). - Unlike cephalhaematoma, it is **not limited by suture lines** and can spread across the entire scalp, potentially leading to significant blood loss. *Caput succedaneum* - **Caput succedaneum** is an **oedematous swelling of the fetal scalp** caused by pressure during head engagement, leading to fluid accumulation above the periosteum. - It is present at birth, often **crosses suture lines**, and usually resolves within a few days, differentiating it from a blood collection limited by sutures. *Intraventricular haemorrhage* - **Intraventricular haemorrhage** is bleeding into the brain's ventricular system and is a serious condition most commonly seen in **premature infants**. - It involves **bleeding within the brain** itself, not an external scalp swelling, and presents with neurological symptoms.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free